Precision functional sphincter-preserving surgery (PPS) for ultralow rectal cancer: a natural orifice specimen extraction (NOSE) surgery technique

• Published in: Surgical endoscopy Vol. 35; no. 1; pp. 476 - 485
• Main Authors: Zhuang, Cheng-Le, Zhang, Feng-Min, Wang, Zheng, Jiang, Xun, Wang, Feng, Liu, Zhong-Chen
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.01.2021; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Anal Canal - surgery; Anastomosis, Surgical - methods; Colorectal cancer; Gastroenterology; Gynecology; Hepatology; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally invasive surgery; Natural Orifice Endoscopic Surgery - adverse effects; Natural Orifice Endoscopic Surgery - instrumentation; Natural Orifice Endoscopic Surgery - methods; New Technology; Organ Sparing Treatments; Ostomy; Postoperative Complications - etiology; Proctology; Rectal Neoplasms - surgery; Rectum - surgery; Surgery; Surgical Stomas; Minimally invasive surgery; Natural orifice specimen extraction (NOSE); Hand-sewn anastomosis; Rectal cancer; Sphincter preservation
• ISSN: 0930-2794; 1432-2218; 1432-2218
• DOI: 10.1007/s00464-020-07989-4

Background In patients with ultralow rectal cancer, surgical resection of the tumor without impairing sphincter function remains a technical challenge. The purpose of this study was to describe a new technique of transanal natural orifice specimen extraction (NOSE) surgery using our independently developed devices, aiming to achieve precise cancer resection and preserve sphincter function in patients with ultralow rectal cancer. Methods Precision functional sphincter-preserving surgery (PPS) was performed on nineteen patients with ultralow rectal cancer between June 2019 and April 2020. With the help of our independently developed devices, surgeons directly and accurately removed the lower edge of the tumor and retained healthy rectal tissue on the nontumorous side. Hand-sewn anastomosis with a mattress suture was used to achieve sturdy anastomosis. Preoperative baseline characteristics, operative details, 90-day postoperative complications, costs, and anal function score at 6 months after surgery were documented. Results Nineteen ultralow rectal cancer patients with a median distance to the dentate line of 2.0 cm successfully underwent PPS without serious postoperative complications. Six out of nineteen patients (31.6%) received a prophylactic stoma. The average cost was 62164.1 yuan. At 6 months after surgery, the average Wexner anal function score and the average Vaizey score were both 3 points. Conclusions PPS can be employed to precisely resect rectal tumors and preserve sphincter function in ultralow rectal cancer patients. The use of our devices enhanced surgical efficiency, reduced the need for prophylactic stoma, reduced surgery-related costs, and prevented abdominal surgical incisions.